Archive for tag:
patients

I *blinked*... and then it was gone. I couldn't even begin to
tell you what's happened over the last week. I took a comprehensive
final over a year and half's material, volunteered at an event, did
a bunch more master's work, and I don't even remember what
else.

Work in the clinic was a little slow last week due to SPC
students being on spring break. We squeezed in a few patient
visits, though, and I had some interesting cases. There was one in
particular, a woman with a pretty complex history of stroke among
other things. I love the variety. You absolutely never know what
you're going to see each day.

We had a pretty good-sized crew to go down to Sarasota last
Saturday. We worked alongside Dr. Arick at the Sarasota-Bradenton
ITU Triathlon. We had several hundred 16- to 19-year-old
triathletes participating in swim-bike-run at Nathan Benderson
Park.

Joe Hicks, Julia Harter, Leslie Jacobi, Dave Aiello, and I did a
ton of soft tissue work on several injured, non-rehabbed athletes.
There were several that had continued training through some pretty
tough injuries. It seems like many of these teenagers have coaches
that push them really hard, but don't attend to their injuries once
it happens.

Julia Harter participated in the Seminole City Fire Truck pull
for the Kiwanas. They raise money for vocational school
scholarships for kids. Dr. Jaya Prakash heads up a lot of events
with them. Dr. Carlo Gaudagno was also at event. Our team won first
place for "mixed adults" and garnered a trophy!

That's about it from me. I finish the master's program this
week. Everything should be done on Friday. I honestly can't quite
grasp it. Here's hoping that this week goes by quickly - but not
too quickly.

I HATE being injured. I REALLY hate it. Inevitably, the doctor
becomes the patient. And everything that you hear about doctors
being horrible patients -- is completely and utterly true. We're
non-compliant, cranky, and just generally difficult. And if you can
imagine the worst of the worst patients -- that would be me.

Why am I telling you this? Well, on Saturday, I hurt my back.
I've done it before, but this time seemed to be worse. There's
something extremely humbling about not being able to do all the
things you normally do: get in and out of a chair, put on pants,
walk. We don't think about it. They've become second nature; we
take them for granted. And even as (almost) doctors, even though
we've maybe felt the pain before, it's really easy to forget how it
feels.

I hobbled into the office Monday morning, and declared, "I need
to be seen by whomever is available as soon as possible." People
cleared their schedules. They juggled patients. People gave up
their treatment times to help me (Thanks, Dave). I sat and filled
out the same paperwork we give to patients. Where is the pain? Does
it radiate? What does it feel like? If you've ever been on the
filling out end of these papers, I'm sure you know what I mean when
I say -- trying to fit how you feel into a form or a diagram is
HARD. I still wrote in the margins.

When my time came, my intern took me back into the patient rooms
and I sat and experienced everything that our patients experience:
the waiting, the orthopedic tests (some confounding and some
painful), the range of motion, the poking and prodding. She drew up
a treatment plan, the doc looked it over, and she went to work.

I'll spare everyone the details, but after a few adjustments and
some soft tissue work, I was sent on my way, to do that to a
patient myself.

It never hurts to be reminded what it feels like. I'm doing
better -- getting a little bit better every day. I'm grateful that
there's a whole team of people here to take care of me, which is
helping me take care of everybody else.

Special thanks to Leslie, this week, for getting me back on my
feet.

Have a great one everyone! I'll be taking part IV boards this
weekend, along with many of my classmates. Good luck to
everyone!

I find myself having the hardest time believing that school is
almost over. As I sit here contemplating what to write, my mind
wanders over things like jobs, moving, and what will happen next.
It's terrifying, and exciting. It also feels like the most daunting
prospect I've ever come across.

I'm starting to look at job postings. In some ways it seems
presumptuous. After all, it's about 6 months away. And at the same
time, I can't help but look. How early is too early to apply? Maybe
I should buy someone's practice. Is that really something that I
can accomplish? Maybe I should just work somewhere for a while
rather than try to make things move on my own. I just can't quite
wrap my head around all of this just yet. There are so many
decisions to make. Where do I begin?

Meanwhile, back at the ranch...

We've had nearly record high numbers of patients at the clinic
for the last couple of weeks. We were shy about 8 last week. Given
the number of cancelations and no-shows that we had, we would have
far surpassed the clinic's highest record. We're lucky to have all
of the SPC students and faculty, as well as the other NUHS students
and faculty as our patient base. It allows us to see a wide variety
of people with an even wider variety of conditions: from eczema to
complex neurological syndromes. Rarely a day goes by without
something unusual. My patients keep me guessing, and laughing. I
really appreciate the sense of humor in many of them. Even in the
midst of pain, they still find time for a smile. It makes my day go
that much easier.

Last week, Julia, Dr. Jourdan, and myself hosted an NUHS booth
at SPC's career day. We were tucked back in the back, but got a
chance to let a few people know about the school, what we do, and
what we offer to other students there. Most of the students at the
career fair were nurses. That didn't stop them from picking up
brochures about the school. We're thinking that maybe we'll end up
with a couple of new students from the day. We've already had a few
start as patients. It's great to get a chance to talk to people,
have them get excited about what we do, and then see them bring it
to fruition.

I guess that's what it's all about, right? Getting your foot in
the door? Maybe that brings me back to looking for a job. I've had
people come out of the woodwork in the strangest of places,
offering me information or connections. As much as I loathe the
concept of networking (yes, I mean that), having conversations with
people and finding out there's some type of mutual interest -- now
that's making a connection.

Hope everyone has a great week. I'll be working and studying for
Part IV boards. We're getting closer...

Do you ever feel like there aren't enough hours in the day? Or
how you got to the end of the day when it all flew by so fast? This
is what it feels like, when I'm busy. The days when I have 3
patients in the clinic (which is the most I've had so far) seem to
fly. There's barely enough time to get all of the paperwork done:
chief complaint, history of present illness... I find that on those
days, it feels like maybe 2-3 hours have passed, and then the shift
is over. How did that happen?

There are a million things that I want to go over with patients.
I take LONG histories; really long ones. I ask questions that
nobody ever asks (and often have to spend time explaining why I'm
asking them). This piece of information is important for that. I
need to know that so I can tailor it for them so I can help them
get better. It never fails. Of course, it's hard to go through all
of that, feel like I haven't left something out, and still get
everything covered.

Of course, one of the great downsides to asking all of those
questions is having to write down all of those notes. I write books
in my patient files. In a way, I feel sorry for my clinician having
to read all of these notes, and then on the other hand, I like
being thorough.

A chalkboard used by Nobel Peace Prize winner Linus
Pauling

Clinic is cooking along. I have a few regular patients, and new
patients coming in here and there. My favorites will always be
those with complex problems, especially functional ones. These
patients need so much more time. Their appointments seem to go by
even faster than the more simple ones. What changes can we make?
Are there things that can be changed? What are the parameters that
we're working with? So many questions, so little time to ask and
answer them.

Research is ongoing. I'm trying to squeeze in articles when I
can, or when I have any free time. Right now I'm reading one about
xenobiotics and autoimmune disorders. Sometimes I think my head
will explode, or at least want to bang it into the wall when I
can't remember what a specific interleukin does (even though I've
looked it up 9,000 times already). Really I just love it, and can
see why people go into research full time. Although, the
application of it is exciting in and of itself. If only I could
know "everything." Of course we'd find new things to learn and
explore, and learn that things that we knew before were completely
and totally wrong, and have to learn them all over again -
differently. I guess that's why we're scientists.

The photo above is from one of Linus Pauling's chalkboards. If
you're not familiar with Linus Pauling, he was the only person to
be awarded two unshared Nobel Peace Prizes. He was a brilliant
chemist/biochemist and activist, and completely changed the way we
think about human biochemistry. He was a huge advocate of
"orthomolecular medicine" (which we now know as functional
medicine), vitamin therapies, and supplementation. I'm absolutely
fascinated by his work, and have had one of his books sitting on my
bookshelf for many months. If only I had the time to read it.

OK, Everybody, go learn something really cool (and then tell me
about it so I can learn too). But in case you're burnt out and
don't want to learn anything, enjoy some Moose yoga. I wish I could
stretch some of my patients out like that!

The trimester is coming to a close, and I can honestly say it's
flown by. We're all scrambling to meet deadlines in the clinic:
this many of this, that many of that. It hardly seems that about 12
weeks ago we were terrified we'd be horrible at this. Truth be
told, I didn't think anything about deadlines and numbers and
paperwork (OK, well I did think about paperwork a little bit).
That's probably why I'm scrambling now.

The last couple of weeks have been discussions about who is
transitioning to the other clinic, and some talks about where we'll
end up. Half of our crew is moving to the other clinic. It's
unlikely that I'll see them very often. Perhaps we'll have seminars
or training sessions of some sort, or get together outside of
school (although we don't do that now). But in a few weeks, there
will be another big transition for all of us. Some of us have been
together, nearly every day, for about 3 years. This will be
something really new.

Newness. It reminds me of my theory about Maslow's Hierarchy
from last week. Incidentally, I've been working some more on that,
but I'll spare you all the details. I had the pleasure to discuss
it with two of my fellow interns today, the concept of new ideas.
We were talking about my theory, and about other theories -- things
in medicine and science that seem to have been left behind. We were
discussing the idea that there are no new ideas.

Image by http://mladavid.deviantart.com

Mark Twain said:

"There is no such thing as a new
idea. It is impossible. We simply take a lot of old ideas and put
them into a sort of mental kaleidoscope. We give them a turn and
they make new and curious combinations. We keep on turning and
making new combinations indefinitely, but they are the same old
pieces of colored glass that have been in use through all the
ages."

I grew up not far from good ol' Mark Twain's stomping grounds,
but between you and me, his writing always made me crazy. No matter
how much I tried, I couldn't understand the dialect he wrote. I'm
not sure that I agree with Mark; it seems we're discovering new
things all the time. From god particles to medicines, we strive and
learn how to change, adapt, and understand the world around us.

If the last 12 weeks in the clinic have taught me anything, it's
that we have no standard approach to treating anything. We have to
be willing to come up with new ideas, or at the very least, new
applications for old ideas. For every patient that comes in, even
if they have the "same" diagnosis, what works for each one of them
is likely to be something completely different.

I'm fairly certain that our discussion today came to the
conclusion that there has to be something new. There has to be a
pursuit of Science that crosses boundaries into new territories,
that bypasses the need for a randomized controlled trial of
everything, and simply embraces discovery for the sake of
discovery, and implementation for the benefit of the whole. Perhaps
we're all idealists. I see no problem with that. Being idealistic
just promotes my love of the field and my hope for making a
difference.

Neil deGrasse Tyson, in his series "Cosmos" said:

"To make this journey, we'll
need imagination, but imagination alone is not enough because the
reality of nature is far more wondrous than anything we can
imagine."

OK, Neil. I'll take that one to heart. The greatest theories
come from crazy idealists.

I wish you all many great new discoveries. May your kaleidoscope
always look just a little bit different.